Most people can start on a STATIONARY bike within the first few weeks after a knee or hip replacement, and ride outdoors from around 12 weeks, once their surgeon has cleared them.
Cycling is one of the best things you can do with a new joint. It’s low impact, it builds your thigh muscles, and after a knee replacement it’s one of the best ways to win back bend.
The exercise bike comes first because you can’t fall off it. The road bike waits until your strength and balance can cope with a sudden stop.
Your surgeon’s advice comes first. If they give you different timings, use theirs.
Starting on the stationary bike
- How soon: many rehab programs add the exercise bike somewhere between 2 and 6 weeks after surgery, depending on the joint, the surgeon and how you’re moving
- Seat height: set the seat high, so the bottom of your foot just touches the pedal with your knee almost straight. A high seat means less bend is needed at the top of the stroke
- Rock before you ride: at first you may not get the pedal all the way round. Push forward until it feels tight, then back, and rock a little further each time
- Backwards first: pedal backwards to begin with, and go forwards once a full backwards circle is comfortable
- Light resistance: little or none to start. You’re after movement, not a workout
- Short and often: start with 10 to 15 minutes twice a day, then build toward 20 to 30 minutes, 3 or 4 times a week. That’s the approach in the AAOS knee replacement exercise guide
- Lower the seat as you improve: a little at a time, as your knee bends further
A full turn of the pedals on an ordinary bike takes roughly 90 to 110 degrees of knee bend, depending on seat height and crank length. If you’re stuck short of that, keep rocking and keep up your other exercises. See exercises after knee replacement and knee stiffness after knee replacement.
After a hip replacement
- Keep the seat high: it stops your hip bending too far at the top of the stroke. If you’ve been given hip precautions, check the set-up with your physio first. See hip replacement precautions
- Getting on and off is the hard part: swinging your leg high over the saddle can be awkward and, with some precautions, off limits. A recumbent bike, where you sit back in a chair-style seat, or a step-through frame makes it easier
- Timing: some hospitals start the exercise bike at about 6 weeks after a hip replacement, others sooner. See hip replacement recovery week by week
The exercise bike is for getting your joint moving. The road bike is for when your balance can handle a sudden stop.
When can I ride a bike outdoors?
- Around 12 weeks is common guidance for road cycling after a knee or hip replacement, and some people get there a little sooner after a partial knee replacement. Get your surgeon’s clearance first
- Before you go, you should be able to pedal full circles easily on the exercise bike, push off from a standstill, balance on your operated leg, and get on and off the bike without wobbling
- Start flat and short: quiet paths, no traffic, short rides. Stop if it hurts
- Plan your stops: come to a stop somewhere flat and put your stronger leg down first if that feels steadier
- Clip-in pedals: leave them until you’re confident. Not being able to get your foot out quickly is a common way to topple over
- Mountain biking and trails: falls are more likely on rough ground, so these usually wait longer. Ask your surgeon
What about e-bikes?
- The upside: the motor takes the strain on hills and into headwinds, makes starting off easier, and can help you keep up with other riders while your legs are still getting stronger
- The catch: e-bikes are heavier and go faster. A fall at speed hurts more, and a heavy bike is harder to hold upright when you stop or wheel it
- Tips: start on the lowest assist setting, choose a step-through frame if you can, and practice starting and stopping somewhere quiet before you ride on roads
Falls are the real risk
The pedaling itself is kind to a new joint. Falling off is not. A fall can break the bone around the implant or, after a hip replacement, dislocate the new joint. Wear a helmet, avoid wet leaves, ice and gravel, and don’t ride when you’re tired or on medicines that make you drowsy.
Go to the emergency department if
- You fall and can’t put weight on the leg
- After a fall, your new hip is suddenly very painful, or your leg looks shorter or turned out
- You have sudden pain or swelling in your calf, chest pain or sudden shortness of breath
Call your surgeon today if
- Your wound is red, hot, swollen or leaking, or you have a fever
- The joint swells badly after riding and doesn’t settle overnight
Mention it at your next review if
- You still can’t get the pedals all the way round after several weeks of rocking
- The joint aches for more than a day after each ride
Start on the bike that can’t tip over. Move to the one that can once your legs and balance are ready.